You should get a notice within 1 – 2 weeks after submitting your claim.
Find out how to file a claim with the Department of Industrial Accidents (DIA) if your employer does not have workers’ compensation insurance.
- This page, File a Claim Against the WC Trust Fund, is offered by
- Department of Industrial Accidents
File a Claim Against the WC Trust Fund
Contacts
Public Information Office
Phone
Phones open M-F 8 am - 5 pm
Phones open M-F 8 am - 5 pm
Toll Free In Massachusetts Only
Call Public Information Office, Toll Free In Massachusetts Only at (800) 323-3249
Phones open M-F 8 am - 5 pm.
Francisco Pena, Office of Claims Manager
Patrick Ronan, WCTF Manager
The Details
What you need
To file a workers’ compensation claim with the Department of Industrial Accidents (DIA) against the Workers’ Compensation Trust Fund (WCTF) you will need to know:
- Your date of injury, illness, or death if a dependent is filing for benefits
- The 1st calendar day of work you missed
- The 5th calendar day of work you missed
- The body parts and types of injuries
- What type of benefits you are looking for
- How long you may be out of work, if known
- Where you first went for treatment
- Your current treating doctor
If you file a claim seeking weekly compensation benefits, you're required to attach a copy of a doctor's report or record not more than 6 months old that describes the extent and length of time of your physical or emotional incapacity for work. This report must also relate your incapacity to your claimed industrial injury.
You are also required to attach a Certificate of No Insurance and DIA Form 170 - Affidavit of Employee in Application for Trust Fund Benefits.
How to file
To file a claim against the WCTF, you, or your attorney, will need to file 3 documents and any supporting documentation as required:
To verify that your employer has no workers’ compensation insurance.
1. Download and fill out an Insurer Request Certification Form. Mail the form to:
Tom Finneran
Office of Insurance
Department of Industrial Accidents
100 Cambridge St., 5th Floor
Boston, MA 02114
- Or submit the request electronically
- This form verifies that the employer has no workers' compensation insurance coverage. The Office of Insurance will send a certified letter called a Certification of No Insurance back.
2. Download and fill out the Form 170 – Affidavit of Employee in Application for Trust Fund Benefits.
3. File the Form 110 via your online account.
- Send supporting documents, Certification of No Insurance, and Form 170 – Affidavit of Employee in Application for Trust Fund Benefits to: Department of Industrial Accidents FAX (617) 727-4551 or email dia-docattach@mass.gov
4. Also send hard copies of all documents by certified mail to:
Workers’ Compensation Trust Fund
c/o Department Industrial Accidents
Lafayette City Center
2 Avenue de Lafayette
Boston, MA 02111-1750
5. Keep a copy for your records.
Next steps
Notification and investigations
You will be contacted by a claims representative and an investigator from the DIA to discuss your claim.
You will receive a notice from the DIA regarding a conciliation for your claim. A conciliation is the first step in the dispute process.
Contact
Address
Phone
Phones open M-F 8 am - 5 pm
Phones open M-F 8 am - 5 pm
Toll Free In Massachusetts Only
Call Public Information Office, Toll Free In Massachusetts Only at (800) 323-3249
Phones open M-F 8 am - 5 pm.
Fax
(617) 727-7470
Address
Lafayette City Center, 2 Avenue de Lafayette, Boston, MA 02111-1750
Address
Lafayette City Center, 2 Avenue de Lafayette, Boston, MA 02111-1750
Fax
(617) 727-6659